Armed with 1940s-vintage flu vaccine technology and supported by only anemic funding for developing truly revolutionary vaccines, the world is woefully unprepared for the next influenza pandemic, and the Trump administration is ignoring the problem, two experts wrote in a New York Times op-ed piece yesterday.

"There is no apparent effort to make [next-generation flu] vaccines a priority in the current administration. Its national security strategy published last month cites Ebola and SARS as potential bioterrorism and pandemic threats, yet makes no mention of the risk of pandemic influenza nor any aspect of critical vaccine research and development," write infectious disease expert Michael Osterholm, PhD, MPH, and his book coauthor Mark Olshaker.

Osterholm is director of the University of Minnesota's Center for Infectious Disease Research and Policy (CIDRAP), which publishes CIDRAP News. He and Olshaker last year wrote Deadliest Enemy: Our War Against Killer Germs, which details the most pressing public health threats and includes a nine-point action plan.

The urgency expressed in the commentary was echoed by other experts.'Worst-case scenario'

In their op-ed piece, Osterholm and Olshaker point out that the infamous "Spanish flu" pandemic of 1918-19 killed 50 million to 100 million people worldwide—at a time when the globe held only a quarter of the population it now houses.

In addition, the current flu season demonstrates how disruptive even everyday seasonal flu can be.

"The next few weeks," the two write, "will highlight how ill prepared we are for even 'ordinary' flu. A worldwide influenza pandemic is literally the worst-case scenario in public health."

Amesh Adalja, MD, senior scholar with the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health, concurs.

"The difficulties currently being experienced in handling a predictable rougher-than-usual flu season should be a wake-up call to all that we will be greatly underprepared for the infectious disease emergencies we are certain to face in the years ahead," he told CIDRAP News.Antiquated weaponry

Outdated flu vaccines lie at the heart of the problem.

"Our current vaccines are based on 1940s research. Deploying them against a severe global pandemic would be equivalent to trying to stop an advancing battle tank with a single rifle," Osterholm and Olshaker write. "Limited global manufacturing capacity combined with the five to six months it takes to make these vaccines mean many people would never even have a chance to be vaccinated.

"The only real solution is a universal vaccine that effectively attacks all influenza A strains, with reliable protection lasting for years, like other modern vaccines."

A universal vaccine targets the "conserved" portion of influenza viruses, the parts that vary little from strain to strain. Such a vaccine would protect against not only the four strains commonly circulating during flu season in any given year but also any strains—such as H7N9 avian flu, which has caused mounting cases in China in recent years—that cause a future pandemic.

"I don't think anything else is more important for public health than developing a universal influenza vaccine," said John Barry, author of The Great Influenza, a definitive account of the 1918-19 pandemic that was said to be instrumental in building momentum for US preparedness efforts during the George W. Bush administration.

"The threat of a pandemic virus aside, a vaccine targeting conserved portions of the virus would very likely be far more effective than current seasonal vaccines, saving hundreds of thousands of lives a year," Barry says. "It makes no sense that it has not been a higher priority in past decades."

Adalja adds, "The pressing need for a universal flu vaccine, as expertly argued in the op-ed, is becoming more critical as the threat of H7N9 looms. Facing such challenges with technology that is obsolete and suboptimally effective is a recipe for disaster."

In Deadliest Enemy, Osterholm and Olshaker paint a fictitious yet chilling scenario of what an H7N9 flu pandemic could look like and how the disease would spread rapidly among today's highly mobile global population.Lack of funding commitment

In their op-ed piece, the pair details the bleak reality of current US funding efforts.

"Although the National Institutes of Health has publicly declared developing a vaccine a priority, it has only about $32 million this year specifically for such research. The Biomedical Advanced Research and Development Authority, the other federal agency responsible for developing and making available new vaccines for emergency response, has in fiscal year 2017 only a single project for $43 million supporting game-changing influenza vaccines."

But together those funds total less than 8% of what the US government spends each year on developing an effective HIV vaccine, which is still a long way off.

"By contrast," Osterholm and Olshaker write, "the search for an H.I.V. vaccine—still a scientific long shot—receives $1 billion annually (which it should). We estimate that international governments, vaccine manufacturers and the philanthropic community must make a similar commitment to influenza vaccine research if the kind of vaccine we need is to developed in the next 10 years."

They note that eradicating smallpox in the 1970s was arguably public health's greatest accomplishment, adding, "We have the tools to potentially accomplish this with influenza, and with the stakes as high as they are, isn't it worth a Manhattan Project-scale effort to defend ourselves?"

A universal vaccine has the potential to be a game changer - if it ever materializes. Without it, a major pandemic sparked by a virus like H1N1 Spanish Flu (or worse) would roll over us without even noticing our attempts to prevent it's spread. Absolutely nothing we do will stop it once it finds it's feet and puts us in it's cross-hairs.

I find it interesting that the 50-100 million figure for deaths attributed to Spanish Flu is far more widely used than it used to be, even by experts like Osterholm. It used to be considered alarmist, but it seems that the lower estimates are now reserved for government officials intent on placating us. The truth is that the reality is far worse than the authorities would have us believe.

100 million people dead during the course of the 1918 pandemic, with as many as 90% of those succumbing to the virus's second wave. Truly terrifying to contemplate when you consider it only lasted about three months, which equates to a million deaths a day in a world with one quarter of today's population and far less reliance on technology. A virus packing the same punch today would see the healthcare system utterly overwhelmed, the lights go out, the faucets run dry, and every store shelf empty in weeks.

Prep well and be ready to shelter in place (or bug out if the situation dictates it) because no government agency will be able to help once it hits the fan.

"Buy it cheap. Stack it deep""Any community that fails to prepare, with the expectation that the federal government will come to the rescue, will be tragically wrong." Michael Leavitt, HHS Secretary.

the flu was rather slow in getting to my neck of the woodsbut it is now here with a vengeancelocal news report says the hospital here (a 225 bed facility) has had over 200 cases of fluthey did not say how many of those cases resulted in hospitalizationbut I can tell you the facility is at capacityone day last week ,according to a reliable source,there were NO general medical bedsNO IMC level beds and only one bed available in the ICUa MAJOR medical facility about an hour away from here has patients in the hallwaysand Friday one local elementary school had one third of their students call in sick

ANYBODY who thinks the healthcare system can effectively deal with a real pandemic is sadly mistakenalready the system is straining

“The point of modern propaganda isn’t only to misinform or push an agenda. It is to exhaust your critical thinking, to annihilate truth.” Gary Kasparov

heard from a reliable source that a local hospital is having problems keeping masks for the staff in stockone floor was running out and called supply for more"they went all over the hospital and found us two boxes"

NOT two cases but two small boxes

“The point of modern propaganda isn’t only to misinform or push an agenda. It is to exhaust your critical thinking, to annihilate truth.” Gary Kasparov

Comment: So, here's something else you can thank the Trump admin for! We're in the middle of an epidemic and medical supplies are running short!

Shortage of medical supplies as Puerto Rico still recovers from hurricane

Health care professionals in the Meriden area and across the U.S. are scrambling to address shortages of intravenous bags and other medical necessities, as Puerto Rico, a major supplier, continues to recover from Hurricane Maria.

“It’s greatly complicating things,” said Eric Arlia, director of pharmacy at Hartford Hospital. “At a minimum it’s taking at least 50 percent of our time managing drug and intravenous, or IV, shortages. After two three-day weekends, it’s more like 80 percent.”

Supplies of intravenous bags have traditionally been tight, but the hurricane has crippled one of three suppliers, Baxter International Corp. who up until recently, was running on generators.

“The medical products industry has a significant presence in Puerto Rico, and the disruption to this industry has had ramifications for patients both on the island and throughout the U.S.” stated Food and Drug Administration Commissioner Scott Gottlieb, M.D. “The FDA has been working closely with federal and Puerto Rican authorities to help stabilize the medical products manufacturing sector.”

Hospitals across the country are reporting shortages of intravenous fluids, particularly sodium chloride 0.9-percent injection bags, a type of saline bag. Saline intravenous fluids, used to inject drugs in hospital and out-patient settings, have been in short supply since 2014, but the electrical issues in Puerto Rico has exacerbated the shortage.

The FDA is working with Baxter to help restore operations on the island, and with other manufacturers.

“This remains a key area of focus for the agency and we expect that the shortage of IV fluids will improve in early 2018 based on the information we are receiving from the manufacturers,” according to the FDA’s latest statement.

Locally, hospitals and doctors within the Hartford Healthcare network are monitoring supply and need, and also talking to manufacturers. They are sharing supplies as needed between facilities, and also using alternative treatments that require staff retraining. MidState Medical Center in Meriden and the Bradley Memorial Campus in Southington are part of the Hartford Healthcare network.

“We meet two times a week with the pharmacy and the supply chain,” Arlia said.

Hospital administrators have also met with U.S. Sen. Richard Blumenthal to explain the challenges.

“We’re asking what can be done to speed recovery of manufacturing and repair the island’s ailing infrastructure,” Blumenthal said.

Further complicating matters, a second supplier – Braun Medical Inc. – was forced to shut down its plant in California three weeks ago for repairs. A third manufacturer, Hosperia, was recently sold to ICU Medical.

“What we really need in this country is more redundancy,” Arlia said. “Things happen. It’s a setup for failure.”

Masonicare in Wallingford is also feeling the pinch as manufacturers ration the supply.

“The shortage is real and a concern to all providers,” said Masonicare spokeswoman Margaret Steeves. “We are fortunate that we have been able to meet our needs and patient care has not been affected; nevertheless, we are watching it very, very closely.”

The Connecticut Hospital Association is also monitoring the situation.

To Deal With a Flu Onslaught, Emergency Rooms Expand Into Waiting Rooms

The Centers for Disease Control and Prevention said in its latest
briefing Friday that hospitalization rates are now similar to those of
the 2014-15 flu season, when up to 56,000 people died from flu-related
illnesses.

“The point of modern propaganda isn’t only to misinform or push an agenda. It is to exhaust your critical thinking, to annihilate truth.” Gary Kasparov

Why blame Trump for shortages of anything. Obama, Bush, Clinton are the ones who chased out of the U.S. all the companies making saline, and all the other items as well as drugs. Trump has been in office for one year and you blame him for everything.

Gee you all believed Obama when he blamed Bush for everything bad...lol you all have short memories! At least Trump is bringing back companies to this country with the new Tax laws! Maybe we can get medical supplies being made in the main land U.S.

We have all known for a long time that the government will not protect us from any pandemic that is why we at all here. So it is not a big surprise that this flu is bad and we may get a worse one. So prep on, some of may live through the bad one and many will die.

I did believe Obama. I was wrong. The previous administration did make things difficult for him, but not impossible. The buck still stops with the President himself, at least in the majority.

Now I have learned from my previous mistake. Even more of the buck stops with the President this time, as his party has the majority in all three houses. He has more manouvering space than Obama did.

More to the point, I can see the money being squeezed out of America's excuse for a health system. This is a nasty year for flu (which any President aware of anything beyond his own ego should have seen) and needed extra funding to prepare, not radically less. Our current government is right-wing, the equivalent of Republican, we are facing a HUGE divorce bill over brexit, the last government left the current one no money at all and yet still it put extra flu plans in place for this year. Our flu cases have peaked already and our death toll is tiny.

The more people covered by health insurance, employment law and welfare, the less people are forced to work when ill. Sick workers spread disease. If you don't want universal healthcare for humanitarian reasons, at least consider it for self-protection.

Ps., Just imagine how things woukd have gone during the ebola outbreak if this had happened before it. Remember Thomas Duncan?

CDC to cut by 80 percent efforts to prevent global disease outbreak

February 1 at 1:53 PM

Four years after the United States pledged to help the world fight infectious-disease epidemics such
as Ebola, the Centers for Disease Control and Prevention is
dramatically downsizing its epidemic prevention activities in 39 out of
49 countries because money is running out, U.S. government officials
said.

The CDC programs, part of a global health security initiative,
train front-line workers in outbreak detection and work to strengthen
laboratory and emergency response systems in countries where disease
risks are greatest. The goal is to stop future outbreaks at their
source.

Most of the funding comes from a one-time, five-year emergency package that Congress approved
to respond to the 2014 Ebola epidemic in West Africa. About $600
million was awarded to the CDC to help countries prevent
infectious-disease threats from becoming epidemics. That money is slated
to run out by September 2019. Despite statements from President Trump
and senior administration officials affirming the importance of
controlling outbreaks, officials and global infectious-disease experts
are not anticipating that the administration will budget additional
resources.

Two weeks ago, the CDC began notifying staffers and officials abroad
about its plan to downsize these activities, because officials assume
there will be “no new resources,” said a senior government officialspeaking
on the condition of anonymity to discuss budget matters. Notice is
being given now to CDC country directors “as the very first phase of a
transition,” the official said. There is a need for “forward planning,”
the official said, to accommodate longer advance notice for staffers and
for leases and property agreements. The downsizing decision was first
reported by the Wall Street Journal.

The
CDC plans to narrow its focus to 10 “priority countries,” starting in
October 2019, the official said. They are India, Thailand and Vietnam in
Asia; Jordan in the Middle East; Kenya, Uganda, Liberia, Nigeria and
Senegal in Africa; and Guatemala in Central America.

Countries
where the CDC is planning to scale back include some of the world’s hot
spots for emerging infectious disease, such as China, Pakistan, Haiti,
Rwanda and Congo. Last year, when Congo experienced a potentially deadly
Ebola outbreak in a remote, forested area, CDC-trained disease detectives and rapid responders helped contain it quickly.

In Congo's capital of Kinshasa, an emergency operations center
established last year with CDC funding is operational but still needs
staffers to be trained and protocols and systems to be put in place so
data can be collected accurately from across the country, said Carolyn
Reynolds, a vice president at PATH, a global health technology nonprofit
group that helped the Congolese set up the center.

This next
phase of work may be at risk if CDC cuts back its support, she said. “It
would be akin to building the firehouse without providing the trained
firemen and information and tools to fight the fire,” Reynolds said in
an email.

If more funding becomes available in the fiscal year
that starts Oct. 1, the CDC could resume work in China and Congo, as
well as Ethiopia, Indonesia and Sierra Leone, another government
official said, also speaking on the condition of anonymity to discuss
budget matters.

In the meantime, the CDC will continue its work
with dozens of countries on other public health issues, such as HIV,
tuberculosis, malaria, polio eradication, vaccine-preventable diseases,
influenza and emerging infectious diseases.

Global health organizations said critical momentum will be lost if
epidemic prevention funding is reduced, leaving the world unprepared for
the next outbreak. The risks of deadly and costly pandemic threats are higher than ever,
especially in low- and middle-income countries with the weakest public
health systems, experts say. A rapid response by a country can mean the
difference between an isolated outbreak and a global catastrophe. In
less than 36 hours, infectious disease and pathogens can travel from a
remote village to major cities on any continent to become a global
crisis.

On Monday, a coalition of global health organizations
representing more than 200 groups and companies sent a letter to U.S.
Health and Human Services Secretary Alex Azar asking the administration
to reconsider the planned reductions to programs they described as
essential to health and national security.

“Not only will CDC be
forced to narrow its countries of operations, but the U.S. also stands
to lose vital information about epidemic threats garnered on the ground
through trusted relationships, real-time surveillance, and research,”
wrote the coalition, which included the Global Health Security Agenda
Consortium and the Global Health Council.

The
coalition also warned that complacency after outbreaks have been
contained leads to funding cuts, followed by ever more costly outbreaks.
The Ebola outbreak cost U.S. taxpayers $5.4 billion in emergency
supplemental funding, forced several U.S. cities to spend millions in
containment, disrupted global business and required the deployment of the U.S. military to address the threat.

“This is the front line against terrible organisms,” said Tom Frieden, the former CDC director who led the agency during the Ebola and Zika outbreaks.
He now heads Resolve to Save Lives, a global initiative to prevent
epidemics. Referring to dangerous pathogens, he said: “Like terrorism,
you can’t fight it just within our borders. You’ve got to fight epidemic
diseases where they emerge.”

Without additional help, low-income
countries are not going to be able to maintain laboratory networks to
detect dangerous pathogens, Frieden said. “Either we help or hope we get
lucky it isn’t an epidemic that travelers will catch or spread to our
country,” Frieden said.

The U.S. downsizing could also lead other
countries to cut back or drop out from “the most serious multinational
effort in many years to stop epidemics at their sources overseas,” said
Tom Inglesby, director of the Center for Health Security at the Johns
Hopkins Bloomberg School of Public Health.

The United States helped launch an initiative known as the Global Health Security Agenda in
2014 to help countries reduce their vulnerabilities to public health
threats. More than 60 countries now participate in that effort. At a
meeting in Uganda in the fall, administration officials led by Tim
Ziemer, the White House senior director for global health security,
affirmed U.S. support to extend the initiative to 2024.

“The
world remains under-prepared to prevent, detect, and respond to
infectious disease outbreaks, whether naturally occurring, accidental,
or deliberately released,” Ziemer wrote in a blog post before
the meeting. “. . . We recognize that the cost of failing to control
outbreaks and losing lives is far greater than the cost of prevention.”

The
CDC has about $150 million remaining from the one-time Ebola emergency
package for these global health security programs, the senior government
official said. That money will be used this year and in fiscal 2019,
but without substantial new resources, that leaves only the agency's
core annual budget, which has remained flat at about $50 million to $60
million.

Officials at the CDC, the Department of Health and
Human Services and the National Security Council pushed for more funding
in the president's fiscal 2019 budget to be released this month. A
senior government official said Thursday that the president's budget
"will include details on global health security funding," but declined
to elaborate.

New Look at 1918/1919 El Niño Suggests Link to Flu Pandemic

El Niño—Spanish for the child—is the name climate scientists have given the occasional periods of Pacific Ocean warming that play havoc with global weather patterns. For example, El Niño is known to intensify winter storms for residents of the West Coast, Gulf states, and southeast United States. El Niño also dampens Atlantic hurricane formation and can increase the number of Pacific hurricanes.

The coming and going of El Niño and disruption of global weather patterns have broad consequences for agriculture, energy consumption, and public safety. Some scientists have proposed that El Niño and its consequences might be intensifying due to global warming. The strong El Niño events of 1982/1983 and 1997/1998 support this idea.

However, a new NOAA-funded study shows that the 1918/1919 El Niño was one of the strongest of the 20th century, a finding counter to earlier analyses that viewed it as weak. This research could ultimately lead to a better understanding of how El Niño events impact weather in the United States and globally. It also suggests a possible link between El Niño and the 1918 flu pandemic. NOAA's Climate Program Office funded the study.

Led by Benjamin Giese, Ph.D., at Texas A&M University, the research team relied on a newly available atmospheric circulation dataset covering 1908 through 1958 to draw a more complete picture of the 1918/1919 El Niño. During World War I, ocean and atmospheric observations were sparse. The lack of direct observations has hampered understanding of the 1918/1919 El Niño.

"What people have been doing to look at past El Niños is to use very sparse datasets and extrapolate based on patterns we know about during recent years," Giese explains. "But those patterns can change."

The team discovered that the pattern of the 1918/1919 El Niño was quite different than those observed in recent years. It was strong in the central Pacific but not along the South American coast. Since most of the observations in 1918 were along the coast, those observations missed the region of greatest warming.

The study raises questions about our understanding of El Niño and climate change. The results from the scientific team's "hindcast" portray El Niño events as stronger at the beginning and end of the 20th century with weaker events in the middle. The scientists say that their method could be applied to other El Niño events for which observed measurements were sparse.

The scientists also noted that the 1918/1919 El Niños central Pacific location links it more closely to drought in India. A severe drought took place in India in 1918, as the monsoon rains failed to develop that summer. The drought coincided with a flu pandemic that was sweeping the globe at that time – with tragic results. The influenza pandemic killed an estimated 18 million people in India. Globally, the 1918 pandemic is thought to have claimed about 50 million lives.

"1918 was one of the worst droughts of the 20th century in India. There was famine and a lack of potable water, thus a compromised population," says Giese. "It is clear that climate played a role in the mortality of peope in India. This is an example of how climate can impact human health. I think it raises intriguing questions."

Co-authors include Gilbert Compo, Prashant Sardeshmukh, and Jeffrey Whitaker of NOAA's Earth System Research Laboratory; Niall Slowey and Sulagna Ray of Texas A&M University; and James Carton of the University of Maryland. Compo and Sardeshmukh are also affiliated with CIRES, the Cooperative Institute for Research in Environmental Sciences, a joint institute of the University of Colorado at Boulder and NOAA.

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